MILK THISTLE DRUG INTERACTIONMilk thistle decreased the trough concentrations of indinavir in humans. [53] However, another study showed milk thistle had no apparent effect on indinavir plasma concentrations. [54] This conflicting data might be due to different milk thistle product preparation, extraction method, product composition, experimental design or even the purity of milk thistle.

MILK THISTLE SIDE EFFECTSMilk thistle appears to be safe and accepted by patients. Only a few cases of milk thistle side effect have been reported. Citations about milk thistle side effects and safety issues from various researchers are summarized as follows:

[1] Silymarin (milk thistle) with few side effects that has been safely used for centuries to treat liver ailments. [55]

[5] Treatment with milk thistle appears to be safe and well tolerated. No reduction in mortality, but improvements in histology and in biochemical markers of liver function among patients with chronic liver disease were found with milk thistle supplement. [59]

[6] Milk thistle was not associated with a significantly increased risk of adverse events. [60]

Note Milk thistle can produce allergic reactions, which tend to be more common among people who are allergic to plants in the same family (e.g. ragweed, chrysanthemium, marigold, and daisy}.__________________________________________________________________________________________

CONCLUSIONS1. Milk thistle has somewhat benefits on liver conditions. But, its effect on hepatitis C is inconclusive.2. Milk thistle extracts are well-accepted, with limited side effects.3. Milk thistle extracts may have benefits of cancer prevention, based on the vitro and animal studies.--v

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INTRODUCTION

Milk thistle, a flowering herb, has been used for treating liver conditions for many years, [1] it appears to be safe and have many other advantages or uses. Milk Thistle extracts may have many benefits, and one of its important benefits is liver protection. Milk thistle extracts have been described to be able to regenerate the liver cells in liver diseases such as cirrhosis (hardening of the liver), jaundice and hepatitis (inflammation of the liver), cholangitis (inflammation of bile ducts resulting in decreased bile flow). Milk thistle may be able to cleanse and detoxify overburdened and stagnant livers, strengthen and tonify weak livers. Milk thistle extract has been used as a gentle and mild laxative, as it may increase bile secretion and flow in the intestinal tract. Milk thistle benefits may also include lubrication and stool softening, it may help to achieve a balance between constipation and diarrhea. Scientific supports to these claims are limited, but there are still some. In the following section, we are going to review what Milk Thistle contains, and how these ingredients affect the beneficial effects of Milk Thistle.__________________________________________________________________________________________Active Ingredients of Milk Thistle

What are the ingredients contributing to Milk Thistle health benefit effects? Milk thistle extracts are standardized to a concentration of 70-80% of flavone lignans including isosilybinin, silybinin, silychristin, and silydianin, which are collectively called silymarin. Silymarin may play a role in displacing toxins binding to the liver and causing the liver cells to regenerate at a faster rate.Silymarin can be extracted from the seeds (fruit). The seeds are used to prepare capsules containing powdered herb or seed; extracts; and infusions (strong teas). [NCCAM]

Silybin (pure, chemically defined substance) and silymarin (flavonoid complex from Silybum marianum - milk thistle seeds) from Milk Thistle have drawn lots of attention. [AA2] As there are lots of evidence that they are anti-inflammatory, cytoprotective, anticarcinogenic, antioxdative and anti-microbial. These effects are probably related to their inhibitory effects on the activation of NF-kappa B. [7] NF-κB is a protein complex that controls the transcription of DNA. NF-κB is involved in cellular responses to stimuli such as stress, cytokines, free radicals, ultraviolet irradiation, oxidized LDL, and bacterial or viral antigens. In a study, silymarin reduced nitrogen monoxide (NO, a free radical) production at less than 300 ppm. [9] Milk thistle extract, silymarin, protects cardiomyocytes against doxorubicin-induced oxidative stress via cell membrane stabilization effect, radical scavenging and iron chelating potency. [41] Silibinin, the pure active ingredient of Milk Thisle, has anti-tumor activities, wherein the mechanism involves the prominent inhibition of the activities of receptor tyrosine kinases (RTKs) and their downstream signal molecules in a variety of tumor cell lines, such as epidermal growth factor receptor 1 (EGFR) and insulin-like growth factor 1 receptor (IGF-1R) signaling pathways. Meanwhile, silibinin also selectively scavenges hydroxyl free radical (*OH) and specifically inhibits the action of nuclear factor kappaB (NF-kappaB). This may explain Milk Thistle's antioxidant and anti-inflammatory effects. Silibinin also attenuates the cognitive deficits induced by amyloid beta protein (Abeta) peptide. [AA1] While, another molecule from Milk Thistle, silybin, inhibited RNA and protein synthesis on gram-positive bacteria in a study. [8] Because of the special properties of Milk Thistle's active ingredients, Milk Thistle extracts or preparations may have many health benefits.

Many scientific studies have been conducted to understand the potent health benefits of Milk Thistle, what Milk Thistle may benefit people at risk or even suffered from chronic diseases such as cancers and liver diseases. This session summarizes the key findings of recent studies on the biological properties of Milk Thistle, and what kinds of benefits Milk Thistle may offer us.

Vascular SystemMilk thistle and lecithin have found to have anti-atherosclerotic activity in rabbits. Milk thistle-phospholipid complex showed a strong anti-atherosclerotic activity. [10] Thus, milk thistle may have benefits on vascular system.

DiabetesMilk thistle extracts may be useful in treatment of non-insulin-dependent diabetes mellitus, as silibinin inhibits glucose-stimulated insulin release in vitro, while not affecting blood glucose concentration in vivo. [39]Aqueous extracts of milk thistle exhibit potent hypoglycaemic and anti-hyperglycaemic activities in normal and streptozotocin diabetic rats without affecting insulin secretion. [40] In a study, researchers treated diabetics with 200 mg of silymarin three times a day. After four months, patients had reductions in blood glucose levels. The results are very encouraging and the researchers planned to do further large multi-centre studies. [Milk thistle may help diabetics -study, Reuters, October 30, 2006.] Thus, milk thistle may have benefits on animals at risk of diabetes.

A study demonstrated that milk thistle was immunostimulatory in vitro. Milk thistle increased lymphocyte proliferation in both mitogen and MLC assays. These effects of Milk Thistle were associated with an increase in interferon gamma, interleukin (IL)-4 and IL-10 cytokines in the MLC (table). This immunostimulatory effect increased in response to increasing doses of Milk Thistle. [43]

Liver diseasesCIRRHOSIS A double blind study of 170 patients with cirrhosis demonstrated that silymarin (milk thistle extract) treatment was effective in patients with alcoholic cirrhosis. [44] A study has suggested that milk thistle and S-adenosylmethionine may be effective in alcoholic cirrhosis. [45]FIBROSIS Milk thistle silymarin retarded the development of alcohol-induced hepatic fibrosis in 12 baboons, consistent with several positive clinical trials. [46] INJURY The hepatoprotective properties of milk thistle extracts in acute and chronic liver injury is probably related to inhibition of leukotriene B (4) formation by silibinin [Milk thistle]. [47] The protective effects of milk thistle on liver injury may be related to the recovery of the membrane fluidities of liver microsome and mitochondria [48] HEPATITIS C A double-blinded trial of 141 subjects demonstrated that milk thistle extract, silymarin, could improve symptoms and general well-being of patients suffered from hepatitis C. [49] However, some researchers found that milk thistle extracts had no benefits on liver health. For instance, milk thistle extract was found to have no hepatoprotective effect on dairy cows. [50] Thus, milk thistle may benefit people at risk of certain liver issues.

Milk thistle may have protective effects on neural systemIn a cell study, milk thistle silymarin significantly inhibited the LPS-induced activation of microglia and the production of inflammatory mediators, such as tumour necrosis factor-alpha and nitric oxide (NO), and reduced the damage to dopaminergic neurons.[51] In a study, milk thistle extract protected cultured rat hippocampal neurons against oxidative stress-induced cell death. [52] Thus, milk thistle may have benefits of neuronal protection.